Neonatal skull depressions may occur from traumatic delivery or abnormal intrauterine position. Surgery has been recommended when the condition is thought to threaten neurologic development; however, normal neurologic outcomes have been observed in conservatively managed infants. A review of four patients with neonatal skull depression is presented together with the obstetric history and findings from nursery examinations, skull roentgenograms, electroencephalograms, and follow-up pediatric visits. Two patients underwent surgical elevation of the depression, while two children with depressions of similar severity were managed without intervention. Neurologic and cosmetic outcomes have been normal in all four patients. It is suggested that uncomplicated depressions should be treated conservatively, with surgical elevation reserved for neonates with intracranial complications.